State of Oklahoma: Historic lack of investment has hurt mental health
Oklahoma City — Thunderbird Clubhouse is pretty good at what it does, which is help people with serious mental illnesses to improve their social, work and life skills, Executive Director Linn Blohm says.
Recently, it's had to do more, though, as people who are homeless or in crisis in Cleveland County come looking for anyone who might be able to help them.
“When I first started, the referrals we were getting, they were people who were stably housed and just needed some structure,” Blohm said. “Right now, we see a lot of people in crisis who can't get into a psych bed because they're all full.”
Oklahoma cut about $52.6 million from mental health services over the last four years, and lost another $80.4 million in federal matching funds, said Jeff Dismukes, spokesman for the Oklahoma Department of Mental Health and Substance Abuse Services. While the legislature last week approved an $11 million increase in the Department of Mental Health's budget for next year, the agency still remains underfunded compared to previous years. And even facilities that didn't endure direct cuts, like Thunderbird in Norman, have had to try to do more as other treatment options dried up.
Nationwide, clubhouses function as a kind of supplement to mental health care. They don't provide therapy or medication, but give members a place to go during the day where they can work on their social, work and life skills. They're purposefully understaffed so that members play an active role in running them, which can serve as a bridge back into the workforce, Blohm said.
When other agencies struggle to hire and keep staff because of low reimbursements from the state, people can't get help there and end up at the clubhouse, which doesn't have the resources they need, she said.
“Some of our members are acting like case managers,” she said. “Instead of having people who come in to work on work skills, people are more focused on surviving.”
Four years of cuts
Because of cuts in mental health funding in previous years, people who have to rely on the state for mental health treatment are receiving fewer hours of individual therapy and wraparound services.
“We know that every cut we make is going to have an impact,” Dismukes said. “You try to find the least-bad choice.”
The mental health department contracts with community mental health centers and other agencies to provide treatment to people who don't have health insurance. The low contract rates limit how many uninsured people each provider can serve, said Terri White, commissioner of the mental health department.
Only about one-third of Oklahomans who need mental health or addiction treatment currently get it, White said. Poor mental health contributes to the state's high rates of incarceration, suicide and physical health problems, she said.
“We have to get to the point where every Oklahoman who has this disease gets treatment,” she said. “Our reimbursement rates are abysmal.”
Mental health outcomes have worsened as the state has reduced its spending on treatment. Law enforcement transports of people in mental health crisis have doubled in the last five years, Dismukes said, and 911 calls related to mental illness also have increased.
Bottom 10 states
Oklahoma ranks in the worst 10 states when it comes to drug deaths, suicide deaths among teens and adults and the number of people reporting they experienced mental distress for two weeks or more in the last month. Oklahoma residents also reported they had more days when they said their mental health was poor in a typical month than the national average.
Bonnie Peruttzi, executive director of Transition House in Norman, said she's seen the same pattern Blohm observed. A decade ago, people who left Griffin State Hospital often went to Norman Alcohol and Drug Treatment Center, which gave them time and support while they processed the trauma that often fueled their mental illnesses and addictions, she said.
Without that assistance, some clients are arriving at Transition House unprepared, Peruttzi said. The process of recovery can be painful, so patients who haven't had enough time and support to learn coping skills may turn back to substances or try to harm themselves again, she said.
“We started to see the revolving door of a lot more quick rehospitalizations,” she said. “It's like having a broken leg and just putting an ace bandage around it and telling somebody, ‘Don't walk on it.'”
Amber Gutierrez, vice president of marketing for CREOKS Behavioral Health Services, said some clients no longer get group or family therapy because of cutbacks in the state's weekly rate. CREOKS, which has clinics across eastern Oklahoma, also has had to reduce access to life and job skills services, she said.
“Every year, things continue to decline,” she said. “When some clients used to get seen two, three times a week, now they're lucky if they get seen one time a week.”
Greater crisis risk
Less-stable clients are a greater risk of going back into crisis when they only see a provider once per week, Gutierrez said. That risk increases even more if they happen to miss an appointment, which isn't uncommon due to trouble with transportation.
“Consistency in treatment is what helps people to get better faster,” she said.
Joy Sloan, CEO of Green Country Behavioral Health Services in Muskogee, said her coworkers used to be able to offer more assistance to clients. The state cut case management services, which help coordinate basic needs like medical care, food and housing assistance, from 25 hours per month to 16 hours per year, she said.
In a well-functioning system, mental health centers would offer comprehensive wrap-around services and slowly pull back as a person recovers and can handle more challenges, Sloan said. As it is, there isn't the money for those services, leaving people more vulnerable to crises that can derail recovery.
“We know that that keeps people out of jails and out of hospitals,” she said. “Our problem in Oklahoma is that we don't invest in people.”